Effect of Modified Duodenal Exclusion Surgery on Glucose Metabolism in Rats with Type 2 Diabetes Mellitus

doi:10.12300/j.issn.1674-5817.2024.056

Abstract

Abstract:

Objective To investigate the impact of anti-reflux modified duodenal exclusion surgery on glucose metabolism in rats with type 2 diabetes mellitus (T2DM), and to elucidate the role of the duodenum in maintaining glucose homeostasis. Methods Forty male Sprague-Dawley rats aged 5 weeks were fed a high-fat diet and induced with T2DM using low-dose streptozotocin. Thirty-six rats that met the T2DM model criteria were randomly divided into three groups: the simple duodenal exclusion surgery group (DE group), the anti-reflux modified duodenal exclusion group (MDE group), and the sham operation group (SO group), with 12 rats in each group. Gastroenterography was performed 4 weeks after surgery, and the body weight, fasting blood glucose levels, and serum glucagon-like peptide-1 (GLP-1) concentrations were measured before surgery and at 1, 2, 4, and 8 weeks post-surgery. Eight weeks post-surgery, the rats were euthanized, and a 1 cm segment of the biliopancreatic loop was collected from each group for pathological sectioning and HE staining to observe the intestinal mucosal villus length under an optical microscope. Results Gastroenterography showed that there was significant reflux of the contrast agent into the duodenal lumen in the DE group, while no reflux was observed in the MDE group. At one week post-surgery, the body weights of rats in all three groups significantly decreased compared to before surgery (P<0.05), and then the body weights of all groups increased over time, with no significant differences between the groups (P>0.05). Compared with the SO group, the fasting blood glucose levels in the MDE and DE groups significantly decreased at all time points post-surgery (P<0.05), while GLP-1 concentrations significantly increased (P<0.05). The fasting blood glucose levels in the MDE group were lower than those in the DE group at all time points post-surgery (P<0.05), but there were no significant differences in serum GLP-1 concentrations between the MDE and DE groups (P>0.05). Regarding intestinal mucosal morphology, the villus lengths of the biliopancreatic loops in the MDE group were significantly shorter than those in the DE and SO groups (P<0.05). Conclusion Anti-reflux modified duodenal exclusion surgery effectively improves glucose metabolism in T2DM rats by preventing the reflux of chyme into the diverted duodenum, thereby enhancing its hypoglycemic effect.

Key words: Duodenal exclusion surgery, Type 2 diabetes mellitus, Blood glucose, Gastroenterography, Intestinal villi, Rats

CLC Number:

R-332

YANG Jin,YU Shiya,LIN Nan,et al. Effect of Modified Duodenal Exclusion Surgery on Glucose Metabolism in Rats with Type 2 Diabetes Mellitus[J]. Laboratory Animal and Comparative Medicine, 2024, 44(5): 523-530. DOI: 10.12300/j.issn.1674-5817.2024.056.

Figures/Tables 4

Figure 1 Surgical illustrations of rats in the duodenum exclusion (DE) group and the modified duodenal exclusion (MDE) group with anti-refluxNote：A, Schematic diagram of the surgical procedure for the DE group. B, Schematic diagram of the surgical procedure for the MDE group. C, Duodenal intestinal lumen tubes made of silicone tubing of about 2 mm in diameter and 4 cm in length, with the head end labeled with a contrast strip for easy identification in imaging. D, One end of the silicone tube was sutured to the intestinal wall, allowing biliopancreatic fluid to flow smoothly from the silicone tube. E, End of the anastomosis after simple duodenal exclusion surgery, with contrast strips marking the biliopancreatic loop and the anastomosis of biliopancreatic loop and common loop to facilitate the identification in postoperative imaging.

Figure 2 Postoperative gastroenterography and body weight changes in DE and MDE rat groupsNote：A, Postoperative gastroenterography of simple duodenal exclusion (DE group, n=11) (the arrow indicates the biliopancreatic loop, with visible contrast reflux into the loop). B, Postoperative gastroenterography of simple duodenal exclusion + tube placement (MDE group, n=10) (the arrow indicates the biliopancreatic loop with inserted tube, with no contrast reflux observed). C, Postoperative body weight changes in three groups of rats (SO, Sham operation, n=12; ns, No statistical difference).

Figure 3 Changes in fasting glucose and GLP-1 levels in the three groups of rats at different time points before and after surgeryNote：A, Line graphs and bar charts showing the changes in fasting glucose levels of the three groups of rats at different time points before and after surgery. B, Line graphs and bar charts of changes in GLP-1 levels at different time points pre- and post-operatively in the three groups of rats. SO group, Sham operation group, n=12; DE group, Simple duodenal exclusion group, n=11; MDE group, Simple duodenal exclusion with tube placement/anti-reflux group, n=10. ns, No statistical difference. * indicates P<0.05, **indicates P<0.01, ***indicates P<0.001,****indicates P<0.000 1.

Figure 4 Morphology of intestinal mucosal villi of biliopancreatic collaterals in three groups of rats after 8 weeks （HE staining， ×100）Note：SO, Sham operation group, n=12; DE, Simple duodenal exclusion group, n=11; MDE, Simple duodenal exclusion with tube placement/anti-reflux group, n=10. ns, No statistical difference. *indicates P<0.05.

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